Insurers collaborate on standards for PHRs

The Robert Wood Johnson Foundation is launching a separate effort to define what elements should be in a patient-held record.

By Jonathan G. Bethely — Posted Jan. 1, 2007

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Health plans are recommending what they consider to be the core elements every personal health record should contain.

America's Health Insurance Plans and Blue Cross Blue Shield Assn. announced last month that they have teamed up to develop a set of personal health record standards. They also said they have developed and tested standards that would allow patients to transfer their information when they change coverage.

The two associations say they represent insurers covering 200 million Americans.

Unlike a paper-based or electronic medical record that doctors create and store in their offices, a personal health record is generally created, owned and maintained by patients.

In this case, however, the health plans' standards will apply to personal health records that are created and maintained on behalf of patients by the plans themselves.

The American Medical Association and others in organized medicine have been supportive of EMR and PHR adoption. But they do not support mandates that doctors use them.

AHIP and the Blues association say physicians would not be required to update PHRs created and distributed by health plans. They said those PHRs would contain medical information already gathered by the insurer through claims data and other means. The records would be updated automatically once a claim is received from a doctor, the insurers' associations said.

AHIP spokeswoman Susan Pisano said the organizations decided to come up with their own standards because physicians urged them to do so. From medications and immunizations to family history and health risk factors, Pisano said there are 15 elements that form the foundation on which every PHR should build.

AHIP has recommended its members adopt the model by 2008. Most of the larger insurers have already agreed to AHIP's recommendations, and Pisano said AHIP will work to assist its smaller members to meet the 2008 deadline.

On Nov. 4, 2005, eight specialty societies sent a letter to AHIP asking it to develop a single PHR standard. The reason stated in the letter was that insurers were coming up with their own standards, and physicians did not want to have to sort through multiple varieties of PHRs. That letter did not advocate a certain set of standards.

"If you deal with eight or nine health plans, the last thing you want is to have eight or nine completely different personal health records," said David Kibbe, MD, senior adviser for the American Academy of Family Physicians' Center for Information Technology.

The AAFP was among those signing the letter to AHIP, as well as one sent six days later to the U.S. Dept. of Health and Human Services. The letter to HHS, signed by 12 medical organizations, including the AMA, asked the agency to use the Continuity of Care Record, produced by ASTM International, a nonprofit standards-setting group, as a guide for what goes into the personal health record.

The CCR standard is a 10-point list that includes emergency contacts, insurance information, medical history, advanced directives and care plans. The only item in the CCR standard that the AHIP/Blues effort does not include explicitly is a patient's spiritual affiliation.

The insurers' effort is not the only one in the area of personal health records. Last month, the Robert Wood Johnson Foundation announced a $4.4 million grant initiative to build new tools for PHRs. The foundation selected nine multidisciplinary teams and will work collaboratively during an 18-month period to design and test multiple PHR applications.

Recently a group of large employers announced an initiative under which they will give electronic portable personal health records to employees through a Web-based framework called Dossia.

A number of companies produce and sell PHRs, and others -- such as Medem, which is partly owned by the AMA -- give them away.

But creating standards is just one challenge, experts say. Dr. Kibbe said there is still work to be done in educating consumers about how to use PHRs. He said until the market creates a tool that consumers find useful, there will be a slew of simultaneous efforts to create PHRs.

"I don't see consumer awareness growing fast right now because I don't see the consumer benefit," Dr. Kibbe said. "I'm sure that people will figure out a way to use the personal health record to the patient's benefit, and then they will take off."

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15 points for a PHR

America's Health Insurance Plans and Blue Cross Blue Shield Assn. have identified core information that will be contained in personal health records created and maintained by health plans. Physicians will not be expected to update data.

Patient information: Demographics, emergency contacts, primary care physician

Family history: Relationship, condition or symptom, status

Physiological information: Blood type, height, weight

Subscriber information: Spouse, children

Encounters: Diagnoses, procedures, prescriptions

Medications: Name, prescription date, dosage, pharmacy

Immunizations: Vaccination date, vaccine name

Benefit information: Eligibility, co-pays, deductibles

Providers: Clinicians involved

Facilities: Where patient receives services

Health risk factors: Habits such as smoking, alcohol consumption, substance abuse

Advance directives: Intubation, resuscitation, IVs, life support, power of attorney

Alerts/allergies: Adverse reactions

Health plan information: For plan-to-plan PHR transfer

Plans of care: Recommendations by care management, disease management

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